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Inmate dies after altercation with jail guards

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Video of Texas prisoner's last hours illuminates debate about privatized healthcare in American jails and prisons

Activist: Privatized care is "so bare-bones ... there's much less understanding on a human level that people might need care"

Correctional healthcare company says it follows American Medical Association standards

(CNN)With five prison guards on his back, Michael Sabbie takes a blast of pepper spray point-blank to the face. Guards then frog-march him to a nurse for a 40-second exam, take him to a shower, where he collapses, then toss him in an isolation cell.

In the span of 10 minutes, Sabbie drools, spits, apologizes, pleads. He never asks the guards to lift up his pants, despite his genitals and buttocks being exposed as he's led through the halls of Texas' Bi-State Jail.

At least a dozen times, he tells prison guards, "I can't breathe."

It's that refrain -- a mainstay of Black Lives Matter protests since Eric Garner died in New York in 2014 after uttering the same three words -- that should have been one of many tipoffs that something was wrong, according to lawyers representing Sabbie's family.

The next morning, on July 22, 2015, Sabbie was found dead in an isolation cell. A medical examiner said he died from natural causes.

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Sabbie's family, upset that the jail didn't do more to help a stricken man, isn't buying it.

The case illuminates an ongoing debate about the quality of privatized healthcare in American jails and prisons, which critics say sacrifices the well-being of inmates to satisfy bottom lines. Prison and prison health care companies counter that they save governments money and their services meet national standards.

Jail videos

There are two recently unearthed videos from Sabbie's last full day. One is a prison surveillance video with no audio. It shows the 35-year-old inmate doubled over, hands on knees, talking to a prison guard. He walks away from the guard, who grabs him by the shirtsleeve and then collar of his prison jumpsuit, spinning him twice and hurling him to the ground.

The altercation began when Sabbie said he wanted to make a phone call and defied an order to return to his cell, his lawyers say.

Guards use pepper spray to help subdue Sabbie.

The second video, captured by a prison guard at the Texarkana, Texas, jail, begins with the guards on top of the 330-pound Sabbie and ends with him whimpering in his cell. A guard on the video can be heard saying they sprayed Sabbie with the chemical agent because he wouldn't stop resisting the officers.

Texarkana Police Chief Robert Harrison handed the investigation to the FBI's Little Rock, Arkansas, office on July 23, 2015, the day after Sabbie was found dead. In August of this year, the family received a U.S. Justice Department letter saying the "evidence does not establish a prosecutable violation of federal criminal civil rights statutes."

Still, the family blames the for-profit firm running the jail, LaSalle Corrections, which they accuse of ignoring accepted medical procedures.

They also say the company refuses to provide transparency into the father of four's death.

A woman answering the phone at LaSalle's offices would not give CNN her name, nor would she provide a name for LaSalle's media contact. "These are my instructions," she said.

Robert "Jay" Eason, director of operations for LaSalle Corrections, later sent an email to CNN saying the company would not comment on the case due to pending litigation.

A Justice Department spokesman also declined this week to comment on the case.

'Number-one complaint'

Experts say that although private prison and healthcare companies must follow state guidelines, a dearth of accountability means private prison and healthcare companies often don't answer to taxpayers.

Marc Howard, director of the Georgetown University Prisons and Justice Initiative, says healthcare is poor "in all prison situations, but typically, it's even worse in private prisons."

Michael Sabbie, 35, was a father of four who loved his kids more than anything, his wife says.

"When it's privatized, it's so barebones, it's so cutthroat, there's much less understanding on a human level that people might need care," Howard said.

Compounding the problem is that prisoners are sicker than the general population, with higher rates of HIV, diabetes, hepatitis C, tuberculosis and other ailments, said Amy Fettig, senior staff counsel for the ACLU's National Prison Project.

"The rates of mental illness are orders of magnitude higher than they are in the general population," she added.

Fettig say she and her staff represent more than 80,000 clients a year. Of the 14 cases on her desk, all but one a class action, 10 involve medical care claims.

"We hear from thousands of prisoners every year and medical care is always the number-one complaint," she said.

It's important to note that prisoners are notorious for faking sickness and injuries to get out of various prison duties, which makes it difficult for guards to tell the difference between real emergencies and phony ones.

On the other hand, CNN has covered numerous lawsuits alleging substandard inmate care. Included are deaths stemming from gangrene, constipation and an asthma attack, all easily treated with modern medicine.

'I can't breathe'

On the second video, Sabbie's condition seems to worsen as the camera continues recording for almost 10 minutes. He's drooling as he waits for a woman with a green T-shirt and pink hair to examine him, which takes less than a minute.

Sabbie makes noises -- "ah, ah, ah" -- as if he's gasping for air. He says, "Please, please" and spits on the floor. Guards take him to a shower.

The guards turn on the water. It runs over the clothed man's body, soaking him. He collapses, his face landing on the shower floor.

Sabbie collapses in the shower, where guards took him to wash off the pepper spray.

The guards pick him up. His pants fall down again. "Ah, ah, ah," Sabbie cries. He's tossed in an isolation cell, uncuffed and given a towel. He struggles to sit up straight.

About 90 minutes later, Sabbie was offered a tray of food for dinner but refused, according to a death report filed with the Texas Attorney General's Office.

Guards checked on Sabbie every few hours throughout the night and noted he was breathing, according to LaSalle's incident reports. But when they went to his cell after 6 a.m. to serve him breakfast, he was dead.

Sabbie, who was awaiting a pretrial hearing on a misdemeanor charge of assault on his wife, had been in the jail less than three days.

A treatable condition?

The autopsy lists hypertensive arteriosclerotic cardiovascular disease as the cause of death. Erik Heipt, an attorney for Sabbie's family, says the respiratory distress Sabbie experienced was a result of pulmonary edema, also cited in the autopsy.

Common symptoms include coughing up blood, wheezing, rapid breathing, sweating and speech inhibited by shortness of breath, all of which Sabbie was experiencing, Heipt said.

The nurse should have monitored his lungs, blood pressure, heart and breathing rate, the attorney said, adding he thinks Sabbie's condition would have been treatable with simple measures including diuretics, nitrates, oxygen and medication.

"The untreated hypertension was causing fluid to build up in his lungs, which put him in acute respiratory distress," Heipt said. "These steps save people with his condition. I am told by a professor of emergency medicine that he was 95-99% savable at any point up to his death."

Sabbie did not exhibit any medical problems when he was admitted to the jail on July 19, the Attorney General's death report stated.

'Shocked and appalled'

The family remains devastated. Sabbie's wife, Teresa, called the video, which she could barely watch, heartbreaking. Sabbie's brother, Marcus, said he was "shocked and appalled" by his brother's treatment and the "total lack of human compassion."

Teresa Sabbie, left, says watching the guards' treatment of her husband was heartbreaking.

"He did everything in his power to try to get help," Teresa Sabbie said in an email response to questions provided to her attorney. "He saw the nurses several times. He begged for help. But he had no power to himself. He was in the complete control and custody of the jail, and they were the only ones who could help him."

Teresa Sabbie said her husband loved his kids more than anything, and his children's lives have been flipped upside down.

The family plans to file a civil rights lawsuit by year's end.

"We can never bring Michael back, but we can make sure this sort of thing never happens again," Teresa Sabbie said.

While a government can offload its malpractice liability, the Supreme Court in 1976 ruled that "deliberate indifference to serious medical needs of prisoners" was on par with whipping prisoners and shoving bamboo shoots under their fingernails, said Marc Stern, who is on the public health faculty at the University of Washington and State University of New York at Albany.

The ruling in Estelle v. Gamble classified deliberate indifference as a violation of the Eighth Amendment's prohibition on cruel and unusual punishment, he said.

"It's not clear how much liability they can offset," Stern said. "Even if they unload malpractice, they may be found guilty of deliberate indifference."

Are all private prisons the same?

Correctional healthcare is not tidily categorized.

There are wholly private jails and prisons, public jails and prisons with privatized health care and all manner of public-private partnerships. Some prisons in New York and Texas farm out health care to other public entities.

In contrast to other experts, Stern said he doesn't believe prisons that use privatized health care -- 40% to 60% of them, he estimates -- provide a lower standard of care. All prison health care is of a low standard, he said, because society stigmatizes prisoners.

More than 2 million Americans are locked up and at least 70 million have criminal records.

"If you ask a guy on the street, that's not high on their priority list - 'Oh, we need to provide better healthcare for rapists and murderers,'" he said.

When Stern oversaw prisoner medical services for the Washington Department of Corrections from 2002 to 2008, he saw the good and bad in every scenario.

It left him believing jail administrators are like nuclear submarine captains. A captain doesn't need to be an expert on nuclear physics, Stern said, "but he better know enough to know if he walks through the submarine that the reactor is overheating."

But private firms are cheaper, yes?

The feds don't think so. Deputy Attorney General Sally Yates issued an August memo directing the Federal Bureau of Prisons to end its use of privately operated prisons. The level of services was only one problem, she wrote.

"They do not save substantially on costs; and ... they do not maintain the same level of safety and security," Yates wrote.

Cost of operations

LaSalle Corrections took over Bi-State Jail in 2013 after undercutting the bid of the previous operator by $17 per prisoner per day. Here's how that compares with what the feds and the state of Texas pay:

Cities, counties and states remain free to use private prisons and prison services if they choose. In 2013, Texas' Bowie County contracted out Bi-State Jail operations, including health care, for a bid of $39.25 per prisoner a day, 30% lower than the previous operator's bid.

Corene Kendrick, a staff attorney for the Prison Law Office in Berkeley, California, says this type of pricing model -- common with private prison companies -- "creates all sorts of perverse incentives for the corporation."

Kendrick says more than half of her cases involve medical care, and she sees a pattern of denying preventative care.

One prisoner lost weight for 18 months but wasn't taken to the hospital until he vomited blood, by which time he had Stage 4 esophageal cancer, she said. Another inmate had a lump on his spine and was told by prison medical staff that once he was free to go straight to a Phoenix, Arizona, hospital. He did, and learned he had a Stage 3 tumor, she said.

"Anytime you introduce the profit motive into something that was traditionally a government function, it raises red flags," she said.

Forgotten factor: Prisoners get out

Stern, the former medical director for Washington prisons, said he only rarely sees instances where care was denied to save money. He has, however, seen instances of doctors missing indicators, which "may be a factor of not hiring good enough doctors."

Underfunding correctional health care is short-sighted, he said. At least 95% of prisoners will be freed, and if their medical needs weren't addressed behind bars, taxpayers will pay far more on the back end, he said.

For example, if drug addiction isn't addressed, prisoners will want to get high when they're free. If HIV isn't addressed, it can become AIDS. High blood pressure, tuberculosis, hepatitis C and some cancers are easily treated in their early stages -- but not so much if they're allowed to progress.

"The health of folks in prisons and jails ultimately affects our health," he said.

What do private prisons say?

A 2014 issue of the Corrections Forum newsletter for jail management professionals says, "Prisons must save in any way they can and outsourcing can bring the best of both worlds - quality and cost."

Corizon Correctional Healthcare, one of the largest such companies, said it follows American Medical Association standards. The company has earned national recognition for its facilities and programs, said spokeswoman Martha Harbin.

"Our commitment to preventive, evidence-based medicine is reflected in some health outcomes that exceed those of the general public," she said.

Corizon saves money not by cutting corners, Harbin said, but through innovation and spreading risk across the company.

Corizon has been recognized for its "robust telemedicine program," which helps reduce the costs of transporting prisoners, she said. It also handles bulk purchases, pharmaceutical needs, insurance claims and credentialing, all of which save public institutions money, she said.

None of Corizon's clinicians "receive compensation based upon financial performance," she said.

So which is better?

Wayne Dicky, president of the American Jail Association and administrator for the Brazos County Detention Center in Texas, cautions against a one-size-fits-all approach.

A jail or prison's size matters, as does its security level. While Dicky's facility maxes out at about 1,100 inmates, major city jails like those in New York and Los Angeles hold thousands.

"A jail administrator has to decide what delivery process works for them," he said. "In big jails with much more complex circumstances, it works to privatize."

In Brazos County, he said, it works better to have clinicians on staff.

Regardless of whether health care is public or private, he said, the onus is on the jail administrator to make sure no one cuts corners. Dicky said he takes caring for prisoners seriously because there is little worse than the tragedy, and optics, of a death in custody.

"I'm sitting in my office right now, and the worst thing that could happen today would be to have someone on my staff hurt or a death in custody," he said.

"I think that the American public is becoming more aware of issues in prisons, both from the ongoing news about exonerations but also from things in pop culture like (TV series) 'Orange is the New Black' that humanizes prisoners," said Kendrick of the Prison Law Office.

When Obama visits a prison in Oklahoma or Netflix uses a women's prison as a setting for a dark comedy, it goes a long way to restoring prisoners' humanity, said Georgetown's Howard.

More than 2 million Americans are locked up, more than 4 million are on probation or parole and at least 70 million have criminal records, meaning fewer degrees of separation between prisoners and the general population, he said.

"They are us. We are them," Howard said. "We need to realize that we're all, in a sense, one step away. This criminal justice system affects everybody."